Christine Jordan Sexton
What charges are appropriate when insured patients appear in hospital emergency rooms?
What if the hospital is under contract with the insurance company but not the doctors who work there–such as anesthesiologists -because they generally are never employees.
An “all star” panel of health care industry experts discussed the issue with members of the Senate Health Policy Committee on Tuesday afternoon.
“Nothing’s ever easy. It’s a complex issue,” Senate Committee Chairman Aaron Bean said as the committee delved into the debate.
Florida law bans out-of-network providers from “balancing billing” HMO subscribers for covered services. There is no balance billing ban on out of network providers on the PPO side, though, and the issue is particularly acute with all hospital based physicians, which in addition to anesthesiologists, usually includes pathologists, and radiologists. While those physicians work at hospitals they rarely are “employees.”
This isn’t the first time the Legislature has eyed the issue. Sean Shaw–the insurance consumer advocate in Florida between 2008 and 2010, tried unsuccessfully to ban balance billing for hospital based services.
The panel heard from representatives of all the impacted parties: hospitals, doctors, managed care plans, ambulance and air ambulance.
Leon County paramedic Mark Kemp told the committee that 100 people in Leon County will be transported to the hospital on any given day by ambulance. Kemp said neither the patient has a choice nor the ambulance service and paramedics.
With the changing the dynamics of the health care market, now is not the time to limit what providers can charge.
“Our systems are already hurting in Florida,” he told the committee. “We cannot take any further economic damage.” He also warned that there are only two ways for ambulance providers to keep afloat–balance bill or have the city or county increase taxes to help offset losses. A third option, he said, is to cut back services.
“That will effect medical outcomes,” he warned.
Baptist Health Jacksonville Senior Vice President Philip Boyce said balance billing has been an outstanding issue for nearly 20 years. His facility, Boyce said, has generally been able to work with patients to help negotiate the bill if there is a non participating provider situation. But 2014 when Obamacare plans arrived–which, he said, brought more plans with out of network physicians into the Jacksonville market– non-participating providers became a larger issue.
Leanne Gassaway, Americas Health Insurance Plans vice president of state affairs, said the issue isn’t unique to Florida. She said the solution is for hospital based physiciand to either join plans networks or begin to have discussions about “reasonable rates.”
Non participating providers, she said, are balancing billing patients at inflated rates that aren’t paid by Medicaid, Medicare, or contracted physicians.
She said physicians needed to “get in network(s) or talk about what a reasonable rate is,” Gassaway said. “We want to pay a fair reimbursement,” she said adding we “want to have an open dialogue about what that is.”
She said insurance companies are under pressure to keep health care affordable for all Floridians. To that end, she said, everyone needs to be “at the table working hard to control costs.”
